Eur J Pediatr Surg 2020; 30(04): 371-377
DOI: 10.1055/s-0039-1683871
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Tracheoscopic Findings and Their Impact on Respiratory Symptoms in Children with Esophageal Atresia

Janina Fischer*
1  Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
2  Medical Faculty, Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
,
Johannes Balleisen*
1  Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
2  Medical Faculty, Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
,
Josef Holzki
3  Former Head of Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany
,
Grigore Cernaianu
1  Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
,
Miguel Alejandre Alcàzar
1  Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
4  Medical Faculty, Experimental Pediatric Pulmonology, University Hospital of Cologne, Cologne, Germany
,
Martin Dübbers
2  Medical Faculty, Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

05. Dezember 2018

07. Februar 2019

Publikationsdatum:
21. März 2019 (online)

Abstract

Introduction Esophageal atresia (EA) is often accompanied by tracheobronchial malformations leading to stridor, recurrent bronchitis, and occasionally to life-threatening obstructive apnea after surgical repair. The aim of this study was to identify the presence of tracheomalacia in patients with EA and tracheoesophageal fistula (TEF) pre- and postoperatively and to find endoscopic correlates leading to clinical airway symptoms.

Methods In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen, localization of TEF, tracheal pulsations, and corresponding clinical symptoms were retrospectively analyzed.

Results The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B–D) compared with patients with EA alone (Gross A) and average tracheal collapse does not significantly change before and after surgical repair of the esophagus in all types. Patients with cyanosis while eating and obstructive apnea presented with an average tracheal collapse of 89%. The presence of respiratory symptoms such as cough, stridor, or bronchitis was not associated with a higher grade of tracheal collapse compared with patients without any airway symptoms (average tracheal collapse of 37% in symptomatic patients vs. 33% in nonsymptomatic patients).

Conclusion Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal collapse of >80%, a ventral pulsation, and obstructive apnea or cyanosis in combination, are at risk for life-threatening situations and further surgical treatment should be considered.

* Janina Fischer and Johannes Balleisen contributed equally to the study.